Provider Demographics
NPI:1275264806
Name:BROWN, KOVA ANNA (CPM, LM)
Entity Type:Individual
Prefix:MRS
First Name:KOVA
Middle Name:ANNA
Last Name:BROWN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:KOVA
Other - Middle Name:ANNA BROWN
Other - Last Name:NANGMENYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N89W15791 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2936
Mailing Address - Country:US
Mailing Address - Phone:414-405-5535
Mailing Address - Fax:
Practice Address - Street 1:3920 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1012
Practice Address - Country:US
Practice Address - Phone:414-405-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPM22050010176B00000X
WI261-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife